Total Lower Lateral Cartilage Reconstruction in Multiple Revision Rhinoplasty Patients.

OBJECTIVE: The aim of this study is to demonstrate a novel surgical technique of total lower lateral cartilage reconstruction using costal cartilage grafts in multiple revision rhinoplasty cases. METHOD: Total lower lateral cartilage reconstruction technique was utilized in 24 patients who underwent open technique septorhinoplasty between 2019 and 2023. Fourteen of the patients were female, and 10 were male. In this technique, we performed total lower lateral cartilage reconstruction in multiple revision cases where the support of both medial and lateral crura was poor. In cases where only the medial crus or only the lateral crus support was inadequate, we performed reconstruction only for the poorly supported portion. A new lower lateral cartilage was created with grafts obtained from the costal cartilage. RESULTS: The mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. CONCLUSION: Multiple revision rhinoplasties present significant difficulties due to complicated nasal anatomy and weakened lower lateral cartilages. We have shown that successful results can be achieved in these complex cases with total lower lateral cartilage reconstruction using costal cartilage grafts. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Sutureless transconjunctival insertion of eyelid gold weight.

OBJECTIVE: Surgical intervention for paralytic lagophthalmos has been gold weight implant through supratarsal crease incision for decades. The aim of this study is to propose a modified novel minimally invasive approach that can be described as sutureless and transconjunctival placement of eyelid weights. METHOD: Unilateral eyelid gold weights were implanted in six patients due to paralytic lagophthalmos secondary to peripheral facial nerve palsy. The patients were followed for an average of 6 months. RESULTS: Functional and aesthetically desired results were obtained in all six patients with suture-free transconjunctival placement of the eyelid weight. The patients did not experience any discomfort and avoided the burden of suture removal after the surgery. No complications developed in six patients during the postoperative period. CONCLUSION: Sutureless transconjunctival insertion of eyelid weight without external incision and suturing is practical, relatively easy and fast to perform. It preserves attachment of the levator muscle to the tarsus and presents functional results similar to conventional method. Fixing the implant with sutures to the tarsal plate is not needed. Sutureless of this method avoids external wound care, burden of suture removal for both surgeons and patients, and hence, suture related complications are eliminated.

Key stone plasty and asymmetric hump resection in crooked nose deformity.

OBJECTIVE: The aim of this study is to propose a new approach in crooked nose deformity with key-stone plasty and asymmetric hump resection. METHOD: Twelve patients with crooked nose deformities were operated using the open rhinoplasty technique. Our method, unlike other methods, has two different steps. Following asymmetric hump resection, cartilaginous and osseous septum were cut separated at the key stone area or more caudally and fix the septum with sutures again by allowing them to slide over each other in a way that directs the septum to the midline. If there is an inability to reveal the septum, we apply a longer spreader graft to the cartilage septum side. RESULTS: The mean ages were 27.4 years. The mean follow-up time of the patients was 19.1 months. No complications were observed due to this technique. This technique was effective in the treatment of all our patients with crooked nose deformities. CONCLUSION: A novel surgical approach with key-stone plasty and asymmetric hump resection method was proposed in crooked nose deformity with a video animation.

Supratip suture and skin scoring technique in the patient with thick skin in rhinoplasty.

OBJECTIVE: The aim of this study is to demonstrate a new surgical technique to achieve ideal nasal tip rotation and projection with nasal supratip angle in patients with thick skin. METHOD: Supratip suture and skin scoring technique was used in 24 patients who underwent open technique septorhinoplasty operation between the years 2019 and 2022. In this technique the nose skin was thinned with scissors. Scoring and supratip sutures were applied to the skin. Kenacort (Triamcinolone 8 mg) was injected into the supratip area without closing the skin. Fourteen of the patients were female and 10 were male. RESULT: The mean age of the patients was 22. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery. CONCLUSION: A new surgical approach has been proposed to create the desired dimensions with nasal tip rotation and projection and supratip angle in patients with thick skin using the supratip suture and skin scoring technique.

Oxidative stress values of tumor core, edge, and healthy thyroid tissue in thyroid masses.

PURPOSE: Reactive oxygen radicals play an important role in tumor formation, progression, and invasion. In this study, the aim was to investigate the relationship between the oxidative stress values of tumor core, edge, and healthy thyroid tissue in thyroid tumors. METHODS: A total of 51 patients with thyroid tumor, 24-malignant, and 27-benign, were included in this study. Samples, measuring 5 × 5 × 5 mm, were taken from the tumor core, edge, and healthy thyroid tissue of the participants. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values were examined. The oxidative stress values of core, edge, and healthy thyroid tissue of all tumors (n = 51) were compared according to the localization. The participants were divided into two groups as malignant (Group 1: Differentiated thyroid cancers) and benign (Group 2: Multinodular goiter). The groups were compared according to tissue localizations. RESULTS: The TOS value of tumor edge was significantly higher than the values of tumor core and healthy thyroid tissue. The OSI value of tumor edge was significantly higher than the values of tumor core and healthy thyroid tissue. There was no significant difference between Group 1 and Group 2 in terms of TAS, TOS, and OSI values of tumor core. The OSI values in tumor edge and healthy thyroid tissue were significantly higher in Group 1 than in Group 2. There was no significant difference between the groups in terms of TAS and TOS values of tumor edge and healthy thyroid tissue. CONCLUSION: The oxidative stress values of tumor edge were significantly higher than the tumor core and healthy thyroid tissue values. The oxidative stress values of tumor edge and healthy thyroid tissue were significantly higher in malignant thyroid tumors compared to benign thyroid tumors.

A Rare and Unexpected Reason for Unilateral Epistaxis: Nasal Septal Schwannoma.

Nasal septal schwannoma is a rare tumor. It causes complaints such as nasal congestion, nosebleeds, and headaches. There are many diseases such as nasal polyps, antrochoanal polyp, chronic rhinosinusitis, concha bullosa, inverted papilloma, and retention cyst with schwannoma diagnosis. The diagnosis is made histopathologically, and the treatment is surgery. In this case report, we presented a male patient with septal schwannoma who had nasal obstruction for a year and reviewed the last 20 years of literature on nasal schwannoma.

Stapedectomy in patients with dehiscent and prolapsed facial nerve.

OBJECTIVE: The aim of this study is to apply the modified stapedectomy technique in cases with dehiscent and prolapsed facial nerve canal, and to compare the postoperative results with those with normal facial nerve canal anatomy. MATERIAL AND METHOD: 28 patients who underwent primary stapedectomy were included. Of the patients, 17 were in the normal anatomical facial nerve group, and 11 were in the dehiscent and prolapsed facial nerve group. Facial nerve was retracted with micro elevator in dehiscent and prolapsed group. and Titanium-Teflon prosthesis was angled and used in accordance with facial nerve course at this group. RESULT: No facial paresis or paralysis was observed in any patient postoperatively. In the first year, no significant difference was found in terms of air-bone gap. CONCLUSION: It is safe to retract the facial nerve for a limited time in cases of stapedectomy in cases with dehiscent and prolapsed facial nerve canal. In these cases, modifying the stapedial prosthesis in accordance with the facial nerve course does not cause disadvantage in terms of hearing gain.

Use of topical fluorescein in the diagnosis and localization of perilymphatic fistula.

OBJECTIVE: The purpose of this video presentation is to demonstrate the effect of intraoperative dilute topical fluorescein in perilympatic fistula diagnosis and localization. MATERIALS AND METHODS: Explorative tympanotomy was performed for the diagnosis, localization and repair of the fistula in the patient who had a pre-diagnosis of perilymphatic fistula. Topical fluorescein was applied intraoperatively to localize the defect. RESULT: A clear change of color was distinguished from yellow to green leading to diagnosis of the perilymphatic fistula and also showed the origin of the fistula. CONCLUSION: Topical application of dilute fluorescein is a convenient and effective tool in the diagnosis and localization of perilymphatic fistula.

A new method in eardrum perforation repair: Accordion myringoplasty technique.

OBJECTIVE: The aim of this study is to describe the accordion myringoplasty technique as a novel method used in the perforation of the eardrum. MATERIALS AND METHODS: The study included thirty patients operated by utilizing accordion myringoplasty technique. RESULTS: We achieved complete closure of the eardrum perforations with the accordion myringoplasty technique in all patients. CONCLUSION: Accordion myringoplasty technique was inspired by conventional fascial and cartilage myringoplasty techniques to protect hearing while increasing surgical success.

A feasibility study in the treatment of obstructive sleep apnea syndrome and snoring: Nasopharyngeal stent.

OBJECTIVE: The objective of this study is to create a new choice of treatment with nasopharyngeal stent in isolated retro palatal obstruction and snoring for the treatment of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHOD: The study included five patients with mild OSAS and snoring. Nasopharyngeal stents were applied in these patients with drug-induced sedation endoscopy. RESULTS: With the nasopharyngeal stents, we aimed to prevent the soft palate to fall backwards while sleeping, especially at supine position in order to prevent the occurrence of apnea and hypopnea, providing a way for the airway to remain open as well as a support behind the soft palate and thus prevent snoring based on the vibration created by draught. CONCLUSION: We suggest a new alternative treatment approach to devices that need to be continuously used such as CPAP or intraoral devices or surgical methods that have many unwanted discomforts for the patients.

The Need for Completion Thyroidectomy in Cases of Differentiated Thyroid Cancer.

There are no definitive criteria for the presence of malignancy in the opposite lobe in cases of unilateral lobectomy due to a thyroid mass in which the malignancy was diagnosed histologically. Study design is retrospective, cross sectional study. The present study included patients who underwent a lobectomy in our clinic between 2001 and 2016 with an initial diagnosis of atypia with undetermined significance or suspected malignancy according to fine-needle aspiration biopsy and adult patients who received a thyroidectomy based on thyroid cancer detected in pathological examinations. Tumor histopathological diagnosis, tumor size, and capsular, vascular, or lymphatic invasion were assessed in patients who received thyroid lobectomy. The presence of a multifocal tumor (52.3%) significantly increased the risk of malignancy in the opposite lobe over the risk association with a unifocal tumor (8.9%; p < 0001). In patients with a tumor diameter greater than 4 cm (83.3%), the risk of malignancy in the opposite lobe was higher than that in patients with a tumor diameter less than 4 cm (22.3%; p < 0.001). Significant differences were not observed between groups with and without vascular or capsular invasion of the opposite lobe (p = 0.913 and p = 0.840, respectively). We determined risk factors for the presence of multifocal disease in unilateral lobectomy materials; an aggressive tumor subtype and a size larger than 4 cm are the most important factors that increase the risk of malignancy in the opposite lobe. Level of evidence Level 4-Case-control studies.

Tracheoesophageal Puncture Site Closure With Butterfly Cartilage Graft.

A tracheoesophageal voice prosthesis is very effective for improving speech after total laryngectomy. Although it is generally a safe method, it may be necessary to close the tracheoesophageal fistula due to complications such as prosthesis-related cellulitis, granulation tissue formation, tracheoesophageal fistula necrosis, or salivary leakage around the prosthesis. Surgical and non-surgical methods for closure have been described. In this article, a method for closing the tracheoesophageal fistula with a butterfly cartilage graft is described. The butterfly cartilage technique is safe and efficient in terms of anatomical closure of the fistula. This study shows that the method can be easily applied, with low morbidity, using an auto-graft material with local anesthesia in an outpatient setting.

Intraoperative thermal safety of endoscopic ear surgery utilizing a holder.

PURPOSE: Despite the ever-growing popularity of endoscopic ear surgery (EES), there are still concerns regarding the potential thermal risk associated with the use of light sources and also questions raised about the thermal safety of extended stationary applications of endoscopes with holders that allow the use of both hands in the middle ear. The temperature changes witnessed during EES when using different calipers on static endoscopes fitted with camera holders during true operations were measured, and effects of varying light source intensities, as well as the cooling effect of irrigation and suction, were investigated. METHODS: This study included 12 patients with chronic otitis who were scheduled to undergo myringoplasty surgery. Two of five different endoscopes with xenon light sources (4 mm-0°, 3 mm-0°, 2.7 mm-0°, 3 mm-45° and, 2.7 mm-30°) were used on each patient. Following irrigation and aspiration, gradually increasing heat measurements were recorded at two-minute intervals using a thermocouple thermometer for the entire period the endoscope remained in the ear. Three measurements obtained within the final 6 min, all of which were the same and reached a plateau, were considered to be the peak heat value. Measurements were repeated twice in each patient at 100% and 50% light intensities. RESULTS: The highest heat was recorded by the 4 mm-0° endoscope, with heats at 100% and 50% light intensity recorded as 48.4 °C and 43.2 °C, respectively. The highest heat was measured by the 2.7 mm-0° endoscope, and heats recorded at 100% and 50% light intensities were 37.8 °C and 35.3 °C, respectively. CONCLUSION: Stationary use of endoscopes with 3 mm and smaller calipers without irrigation or aspiration, the heat in the middle ear would appear to be safe, and at a level that does not cause thermal trauma to tissue. The present study demonstrates that frequent aspiration or intermittent irrigation may prevent potential thermal damage, even in procedures performed using endoscopes of a 4 mm caliper. Light intensity settings of 50% can be adopted as a further safety measure against potential thermal risk without compromising visual acuity.

Adjunctive Use of the Dermocartilaginous Ligament for Dorsal Irregularities in Primary Rhinoplasty.

Nasal dorsal irregularity is a common postrhinoplasty complication in spite of meticulous smoothing. Utilization of the dermocartilaginous ligament in 2 different fashions for different purposes was described before. A novel utilization of the dermocartilaginous ligament as a flattened and pedicled flap from the cephalic attachment for nasal dorsal irregularities was presented in this article. This surgical technique was applied in 11 cases. Eight of them had thin skin, 2 had skin with medium thickness, and 1 had thick skin. They were followed on an average for 27 months (between 6 and 37 months). All of the patients had satisfactory esthetic results, and there was no apparent irregularities observed over the nasal dorsum. No complications such as infection or hematoma occurred during the early or late follow-up periods. Instead of discarding the dermocartilaginous ligament, it can be used adjunctively to conceal the nasal dorsal irregularities to attain a smoother dorsal nasal surface by increasing soft tissue cushion over the osseocartilaginous dorsum. Transposing of the dermocartilaginous ligament also relieves dynamic drooping of the nasal tip, shortening of the upper lip, and undesirable gingival display.

Effects of a Thermosensitive In Situ Gel Containing Mometasone Furoate on a Rat Allergic Rhinitis Model.

Background Mometasone furoate, one of the second generation intranasal corticosteroids, is currently used in suspension form due to its poor solubility. However, this is not favorable for nasal application because of the rapid elimination of the instilled drug from the nasal cavity by mucociliary clearance and delayed onset of action due to the slow dissolution of drug in suspension. Objective The aim of this study was to determine the antiallergic effects of mucoadhesive thermosensitive in situ gel containing mometasone furoate that we developed previously to prolong the contact between the drug and nasal mucosa and to prevent drainage of the formulation in an ovalbumin-induced rat model of allergic rhinitis. Methods An experimental allergic rhinitis model was developed in female Wistar albino rats by intraperitoneal injection of ovalbumin every 2 days for 14 days followed by its repeated intranasal instillation for 7 consecutive days. Intranasal instillation of ovalbumin was continued every other day for 14 days. Mometasone furoate in situ gel (5 µg/10 µl), mometasone furoate suspension (5 µg/10 µl), and physiological saline (10 µl) were administered into the bilateral nasal cavities from day 22 to day 35. Antiallergic effects were evaluated through histopathological evaluation, analysis of ovalbumin-specific serum immunoglobulin E, and a symptom score. Results Mometasone furoate in situ gel significantly decreased the nasal symptoms and ovalbumin-specific serum immunoglobulin E level as compared with mometasone furoate suspension and physiological saline. Additionally, inflammatory histological symptoms such as mucosal edema, vascular dilatation, eosinophil infiltration, and loss of cilia within the nasal mucosa of allergic rhinitis model rats were remarkably improved with the treatment of mometasone furoate in situ gel. Conclusion These results suggest that mometasone furoate in situ gel has a better therapeutic potential for the treatment of allergic rhinitis compared to mometasone furoate suspension.

Effect of nasal antihistamine on secretory IgA in nasal lavage of rats.

The humoral IgA is an immunoglobulin which plays a defensive role for organisms on mucosal surfaces. Today, intranasal antihistamines are effectively used in the treatment of allergic rhinitis. In our study, the effect of azelastine hydrochloride-a nasal antihistaminic-on humoral IgA of the nasal mucosa has been reviewed empirically. Twenty-four female Sprague-Dawley rats were included in our study. The rats were divided into three groups randomly. Group 1(azelastine hydrochloride): rats in this group had nasal azelastine hydrochloride (0.05%) applied for 30 days at 10 µl/nostril dosage. Group 2 (saline): saline (0.09%) was applied to the rats in this group for 30 days at 10 µl/nostril dosage. Group 3 (control): no application was made throughout the study. The chemicals applied in Groups 1 and 2 were applied to both nostrils by mounting a flexible micropipette to the end of an insulin injector. At the beginning of the study, nasal lavage was performed to both nostrils of the rats in every group on the 15th and 30th day to aspirate irrigation solution (distilled water). The aspirated liquids were kept at - 80° temperature and reviewed together at the end of study. Within-group comparisons: in Group 1 (azelastine hydrochloride), the humoral IgA value on the 15th day was significantly higher than the basal value (p = 0.037). There is a significant difference between humoral IgA value on the 30th day and humoral IgA value on the 15th day (p = 0.045). In Group 2 (saline), no significant difference is available between basal, 15th day and 30th day humoral IgA values (p = 0.265). In Group 3 (control), no significant difference is available between basal, 15th day and 30th day humoral IgA values (p = 0.374). Between-group comparison: there is no significant difference in between-group humoral IgA basal values (p = 0.714). On days 15 and 30, Humoral IgA value of Group 1 was significantly higher than that of Groups 2 and 3 (p = 0.013, p = 0.024, respectively). According to the results we achieved in our study, nasal antihistaminic (azelastine hydrochloride) significantly increases the level of humoral IgA. Our study is the first one in the literature to reveal a relation between nasal antihistaminic and humoral IgA and there is a further need for clinical, randomized and prospective studies.

Proposal of a Budget-Friendly Camera Holder for Endoscopic Ear Surgery.

Endoscopic ear surgery (EES) is increasingly a preferred technique in otologic society. It offers excellent visualization of the anatomical structures directly and behind the corners with variable angled telescopes. It also provides reduced operative morbidity due to being able to perform surgical interventions with less invasive approaches. Operative preparation and setup time and cost of endoscopy system are less expensive compared with surgical microscopes. On the other hand, the main disadvantage of EES is that the surgery has to be performed with 1 single hand. It is certainly restrictive for an ear surgeon who has been operating with 2 hands under otologic microscopic views for years and certainly requires a learning period and perseverance. Holding the endoscope by a second surgeon is not executable because of insufficient surgical space.Endoscope/camera holders have been developed for those who need the comfort and convenience afforded by double-handed microscopic ear surgery. An ideal endoscope holder should be easy-to-set up, easily controlled, providing a variety of angled views, allowing the surgeon to operate with 2 hands and, budget-friendly. In this article, a commercially available 11-inch magic arm camera holder is proposed by the authors to be used in EES due to its versatile, convenient, and budget-friendly features. It allows 2-handed EES through existing technology and is affordable for surgeons looking for a low-cost and practical solution.

Effect of a combination of mometasone furoate, levofloxacin, and retinyl palmitate with an in situ gel-forming nasal delivery system on nasal mucosa damage repair in an experimental rabbit model.

BACKGROUND: In this study a combination of Mometasone Furoate (MF)+Levofloxacin hemihydrate (LH)+Retinyl palmitate (RP) with an in situ gel-forming delivery system was evaluated at different stages of nasal mucosal damage repair in a rabbit maxillary sinus model. METHODS: In this study, 28 rabbits were included and assigned randomly to four groups. In all rabbits, a standard ostium was opened in the medial wall of the maxillary sinus by using a drill. Two different subsequently prepared gels with an in situ gel-forming delivery system were used. Of these 14 nasal cavities, combination 1 (active combination) was applied daily to 5, combination 2 (placebo) to 5, while 4 did not receive any pharmaceutical treatment. The diameter of the ostium was measured. Histopathological assessment was performed. RESULTS: After 2, 3 and 4 weeks, the ostium diameter was significantly wider in the group where gel 1 had been applied compared to both the placebo group and control group. In the group treated with gel 1, after 2, 3 and 4 weeks the presence of superficial cilia was significantly greater, surface epithelium significantly less. In the 4th week, histologic scores for fibroblastic proliferation and vascular proliferation in the group treated with gel 1 were better than in either the control group or the placebo group. With gel 1, chronic inflammation parameters were also significantly lower than in the other groups. CONCLUSION: The MF+LH+RP mixture with an in situ gel-forming nasal delivery system applied for wound healing after FESS prevents the formation of stenosis and is favorable for proper wound healing.

Temporal Scalp Thickness, Body Mass Index, and Suprafascial Placement of Receiver Coil of the Cochlear Implant.

OBJECTIVE: The objectives of this study are to demonstrate the relationship between the thickness of the temporal scalp and body mass index (BMI), age, and sex, and to present the surgical technique which we perform in patients with a thick scalp. MATERIALS AND METHODS: This is a retrospective, cross-sectional study. This study was performed in a tertiary referral center. Cranial computed tomography images of 469 subjects were included in the study. These subjects were evaluated according to BMI, age, and sex. These individuals were divided into 6 groups based on the BMI levels. Differences between the groups were compared in terms of temporal scalp thickness. In 5 patients with a mean scalp thickness of 9.7 mm, the receiver coil was placed over the temporal muscle fascia through a transmuscular incision without surgical thinning of the skin flap. RESULTS: Average scalp thickness was measured as significantly higher in males than in females, with advancing age, and increasing levels of BMI. In 5 adult patients with a scalp thickness measured as ≥7 mm who underwent cochlear implantation, suprafacial placement of the receiver coil achieved successful surgical and audiological results. CONCLUSION: Thinning of the skin flap is recommended in patients with a scalp thickness ≥ 7 mm to provide effective transmission, minimalized power requirement, and magnet retention. Suprafascial placement of the receiver coil can be recommended in patients with a thick scalp without any excisional thinning impairing integrity and vascularity of the skin.